Penis enlargement

Penis enlargement procedures (sometimes euphemistically referred to as male enhancement procedures in spam email and television advertisements)^{[citation needed]} are techniques alleged to make the human penis increase in girth, length, or hardness. Often, in the course of advertising fraudulent products, the distinction between temporary enlargement, i.e. erection, and permanent enlargement, is deliberately muddied.

Procedures range from manual exercises to stretching devices and surgical procedures, with reports of successes and failures around the world. While some of these are known to be outright hoaxes, other techniques have some measure of success.

Very little legitimate scientific research has been done specifically on penile enlargement, so any claims of significant and permanent enlargement can be biased or anecdotal. General research has been done regarding the efficacy (or rather the lack of) of the contents of the pills; otherwise, one assumes, that main-stream medicine would have made use of them if they indeed worked in any setting. There is also an element of risk with some of the more invasive procedures, with negative outcomes ranging from the tearing of skin and scarring, to permanent loss of sexual function. Due to the speculative nature of any hope for "improvement" and the many known cases of permanent injury involved in this endeavor, many medical professionals are sceptical of the subject.^[1]

At present there is no proof in the scientific community of any non-surgical technique that permanently increases either the thickness or length of the erect penis that already falls into the normal range (4 to 6 inches).

Much of the marketing of pills and potions appears based on the unproven (perhaps false) premise that women require men to have large penises for any kind of sexual relationship. It may be concluded that a worry about the size of ones penis may be (in extreme cases) a psychological/psychiatric condition best dealt with by qualified medical practitioners.

Increasing the size of the "normal size" penis must be distinguished from the seeking of a remedy for the recognised medical condition known as micropenis where surgery to increase the organ's size is sometimes needed for urinary or sexual purposes.

The surgical method of penis lengthening is controversial in the medical community. One surgery to widen the penis involves cutting it open and implanting radiated cadaver skin around the central shaft. Some doctors lengthen the penis by cutting the suspensory ligament through the scrotal approach along the middle suture of scrotum — this operation is named ligamentotomy. The healing takes just a couple of days and the operation is minimally invasive but is just of complementary character: one should be attaching a weight or penile extender to the end of the penis daily for 6 months.^{[citation needed]}

Cosmetic

Rather than attempt to change the actual size of the penis, one may make it appear bigger, by trimming the pubic hair or by losing weight.

Pills and supplements

"Penis enlargement pills", "penis patches" and ointments are commonly offered over the Internet. While some products contain only safe and natural ingredients, many are entirely untested for any side effects in legitimate studies.

According to a study published in the Journal of Urology, L-Arginine can increase Nitric Oxide metabolites and enzymes in the bloodstream^[2]. Based on this effect, there are some "penis enlargement pills" that are sold containing L-Arginine that make claims about effectiveness.

Penis pump

A penis pump is a cylinder that is fitted over the penis, with a manual or motorized pump to create suction. As the apparatus creates a partial vacuum around the penis, blood is drawn into the penis, helping it to become engorged. As vacuum increases, the difference between the inner blood pressure and the pump pressure increases as well; excessive pressure causes vascular damage rather than a harder penis.

Penis pumps, usually described in this context as vacuum pumps, have use in conventional alleviation of impotence. The pump itself is essentially as described above, although often made to higher standards of quality with a much higher price, and arrangements for distribution by suppliers of medical equipment. The purpose is not to cure the condition, but to attain an erection by mechanical and hydrodynamical means even if there is nerve and vascular damage preventing a full natural erection; once the penis is erect, a compression ring is slid on to maintain the erection which will otherwise subside immediately.

A flexible compression ring (or sometimes more than one), commonly called cock rings when used recreationally, must be used. It is fitted on the open end of the cylinder, then an erection is created by pumping. Then the ring is pushed by hand onto the base of the erect penis before releasing the vacuum. This restricts blood flow out of the now erect penis, enabling the erection to be held even in the presence of problems of the vascular or nervous system which would otherwise lead to immediate loss of erection. In the best circumstances erections can be maintained for a considerable time, but manufacturers' literature recommends that, for safety, rings should be removed after no more than 30 minutes. Very prolonged use (hours) will cause permanent harm.

A personal lubricant of a type not harmful to the ring material is used, primarily to make a good seal at the base of the pump to prevent air leakage, in the same way that vacuum grease is used with a laboratory vacuum pump. It also makes it easier to slide the ring off the cylinder, and later to remove the ring.

Pumping must be done very carefully to avoid serious injury: over-enthusiastic pumping can burst blood vessels and form blisters. In some cases the testicles can be unexpectedly pulled into the cylinder, causing discomfort, pain, and possibly injury.^{[citation needed]} It is also believed that the rim of the cylinder can cut into the skin and over time cause damage to the ligaments surrounding the penis. Impatiently pumping without reading explanatory material can produce too much suction (any pressure lower than 10 torr/1,333 Pa)^{[citation needed]} and cause permanent and irreparable injury. Attempts at using vacuum cleaner units for this purpose have resulted in extremely severe injuries because the suction is far too powerful.

Pumps used with rings are virtually always effective, as they operate by a simple mechanical process, in cases of ED, even when pharmaceutical methods fail. They may nonetheless be found unsatisfactory due to the inconvenience and similar factors.

The effectiveness of penis pumps for permanent penis enlargement was examined by Kazem, Hosseini and Alizadeh. They studied 37 men with penis length less than 10 cm and found no significant change in penile length after using pumps for six months, although the follow-up have found 30% satisfaction with the method. The conclusion of the paper stated that vacuum treatment of the penis is not an effective method for penile elongation, but provides psychological satisfaction for some men.^[3]

A 31-patient study conducted by the Department of Urology at St Peter's Hospitals and the Institute of Urology in London investigating the usefulness of pumps to correct the penile curvature associated with Peyronie's disease found that "There was a clinically and statistically significant improvement in penile length, angle of curvature and pain after 12 weeks of using the vacuum pump". In this study, subjects with Peyronie's undertook two ten-minute pumping sessions per day for twelve weeks. The additional penis length of 0.5 cm average was an unexpected side effect found in approximately one third of the subjects and not an intended aim of the study. ^[4]

In the US, Penis pumps may be funded by Medicare, where a patient's erectile dysfunction is deemed to necessitate this.^[5]

Stretching

Stretching consists of attaching a penis extender or "stretcher" device to the penis for set periods of time. The device exerts a constant traction on the penis, which, in theory, lengthens and widens the penis, although this can be very dangerous^{[citation needed]}. The traction supposedly causes the cells in the penis to divide and expand. ^{[citation needed]}. The "efficacy" of penile extender has been studied and shown to increase penis length. The primary end point of the study was changes in flaccid and stretched penile lengths compared with the baseline size during the 3 months follow-up. Twenty-three cases with a mean age of 26.5 ± 8.1 years entered the study. The mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow-up, which was statistically significant (P < 0.05). Mean stretched penile length also significantly increased from 11.5 ± 1.0 cm to, respectively, 12.4 ± 1.3 cm and 13.2 ± 1.4 cm during the first and second follow-up (P < 0.05). No significant difference was found regarding proximal penile girth. However, it was not the same regarding the circumference of the glans penis (9.3 ± 0.86 cm vs. 8.8 ± 0.66 cm, P < 0.05).^[6]

Jelqing

Jelqing or "milking" is a specific method for stressing tissues in the penis, with the goal of permanently increasing its maximum erect size. In jelqing one repeatedly wraps one's thumb and index fingers around the base of the semi-erect penis and then draws them tightly up the shaft. This engorges the glans and promotes vascularity in the corpus cavernosum and associated tissues.^[7] The term "jelqing" is also commonly misapplied to related exercises such as pelvic floor flexing or to penis enlargement exercise in general.

The jelq process is not a miracle of nature. As with any muscles or glands in the body, the penis will stretch over time, if pressure is applied. The practice of jelqing is said to go back thousands of years and originates from Arabic cultures where it was common practice for men to show their male children the proper jelqing technique. Recent studies and medical professionals have been researching the effect of a well-followed jelq program.^[8]

Clamping

Clamping is a risky and dangerous technique. The goal of clamping is to increase the growth of the penis. This enlargement technique uses a constricting device, such as a shoe string, cable clamp, or a tight cock ring. The device is firmly tied, clamped, or put, respectively, on the base of the erect penis while "edging" (extended masturbation) with a firmly erect penis. Use of a metal cock ring is not advised because trapped blood engorging the penis can make it impossible to remove without amputation or emergency intervention such as sawing the ring off. Clamping is considered extremely dangerous by both practitioners and the medical community as it can cause permanent catastrophic damage to the penis.

Hanging

Weight hanging consists of attaching a device (usually a rope or a strap) that grips the glans or just behind the glans and allows a weight to be suspended for a specific amount of time. Then a conscious effort is made to exercise the penis by raising the weight in repetitions (lasting no more than 5 to 10 minutes at a time) starting with the smallest and lightest weight 1/16 pound to the heaviest usually 1/4 pound or more.^{[citation needed]}

Weight hanging, however, can also carry serious risks, which include nerve damage, chronic pain, scarring and impotence. The idea behind weight hanging is to stretch the tunica albuginea and other various tissues of the penis.^{[citation needed]}

Hanging carries additional health risks due to the restriction of blood flow to the glans, including testicular cancer.